Bacterial Tracheitis Summary

Key Features:

Pathogens:

Critical Management:

Differential Diagnosis:

Emergency: Suspect in croup-like illness with poor response to adrenaline/steroids and high fever

Bacterial Tracheitis

Diagnosis and Management Guidelines

Bacterial tracheitis may occur at any age. In the early phase, patients may present similarly to croup however there is a failure to respond or only transient response to steroids/nebulised adrenaline and the condition worsens.

In this condition, the larynx, trachea and bronchi can become obstructed with purulent debris. There is an adherent pseudomembrane that forms over the tracheal mucosa that can slough off causing an obstruction. There is normally a preceding upper respiratory tract infection for a couple of days, followed by a rapid deterioration with a pyrexia and respiratory distress. There is a cough producing copious secretions and retrosternal pain. There is no dysphagia or drooling – unlike epiglottitis.

Causative Organisms

Most Common Pathogens

  • Staphylococcus aureus (41%)
  • Haemophilus influenzae (18%)
  • Streptococcus pneumoniae (15%)

Less Common Pathogens

  • Moraxella catarrhalis (13%)
  • Streptococcus pyogenes (9%)

Management

Critical Interventions

  • Intravenous antibiotics (empiric therapy covering S. aureus)
  • Endotracheal intubation often required for airway control
  • Close monitoring for respiratory failure

Clinical Course

  • Young children can deteriorate quickly due to smaller airways
  • Mean hospital stay: 3-12 days
  • Full recovery expected in most cases

Complications

Acute Complications

  • Pneumonia (most frequent)
  • Acute respiratory distress syndrome
  • Septic shock
  • Pulmonary edema

Other Considerations

  • Pneumothorax
  • Cardiorespiratory arrest (rare)
  • Potential for subglottic stenosis (due to intubation in inflamed airway)

Croup vs Epiglottitis vs Tracheitis

Feature Croup Epiglottitis Tracheitis
Incidence Common Rare Rare
Age 6m-3y 2-5y (and adults) 6m-14y
Aetiology Viral Bacterial Bacterial
Onset Slow Very rapid Rapid
Fever Rarely >39°C Usually >39°C Usually >39°C
Cough Barking Suppressed Productive
Voice Hoarse Muffled Hoarse
Position Supine Sitting forward Supine
X-ray Findings Steeple sign (AP) Thumbprint (lat) Hazy trachea
Response to Adrenaline Very good No response Partial/none